Building a Screen for Cancer Survivorship-Occupational Therapy Services (SOCS-OTS): a classical Delphi study

PURPOSE

The purpose of this study was to develop and validate items for the Screen of Cancer. Survivorship - Occupational Therapy Services (SOCS-OTS), a patient-driven screening tool to be used by frontline workers and filled out by cancer survivors that can indicate a need for appropriate occupational therapy (OT) referral.

METHODS

Five rounds of a classical Delphi study were conducted to determine item inclusion. Expert panelists in rounds 1 and 2 consisted of adults LWBC who verified proposed items relevant to issues in activities of daily living (ADLs). Expert panelists in rounds 3-5 consisted of expert OTs who determined item relevance through consensus and item modification.

RESULTS

Forty-five adults living with and beyond cancer (LWBC) and 14 expert oncology occupational  therapists and researchers participated in five rounds of surveys. A total of 20 items reached consensus at 80% with a "check all that apply" format. Items included address ADLs meaningful to adults LWBC.

CONCLUSIONS

The SOCS-OTS is an innovative content-valid screening tool designed to identify problems with ADLs relevant to OT referral.

IMPLICATIONS FOR CANCER SURVIVORS

The SOCS-OTS can empower cancer survivors and cancer care teams by indicating when daily activities are impacted enough to refer to OT services. This could ensure that cancer survivors receive the rehabilitation services they need.

Building the Screen of Cancer Survivorship–Occupational Therapy Services (SOCS-OTS): A Delphi Study

Date Presented 03/31/2022

Researchers will review a classical Delphi study that formally validated the Screening of Cancer Survivorship-Occupational Therapy Services (SOCS-OTS). The tool was developed for oncology team members to identify those who need OT services because of occupational performance limitations. The SOCS-OTS is the first screening tool for oncology teams to address the broad spectrum of occupational performance issues at various points in the survivorship continuum.

Primary Author and Speaker: Katie M. Polo

Additional Authors and Speakers: Daria L. Seccurro, Taylor Henson, Jordan Walker, Kenzie Salzbrenner, Michael Wroblewski, Shanele Tyler

Early treatment of severe mandibular hypoplasia with distraction mesenchymogenesis and bilateral free fibula flaps

The technique of distraction has revolutionized the treatment of mandibular hypoplasia; however, presently large mandibular defects still require bone grafts. Microvascular grafting is commonly used in adults. Conversely, in pediatric reconstruction, nonvascularized rib grafts remain standard. Unfortunately, resorption of nonvascularized bone remains a major issue, particularly when soft tissue is hypoplastic. This case study represents a combination of techniques in the treatment of severe mandibular deficiency, and introduces the concept of distraction mesenchymogenesis. The patient was a 2 1/2-year-old boy with severe bilateral Pruzansky class III mandibular hypoplasia. He had a permanent open mouth posture, an overjet of 23 mm, and was unable to move the lower mandibular segment. His oropharyngeal airway diameter was 2.2 mm and he was tracheostomy dependent. The patient was treated with distraction of the lower jaw mesenchyme followed by bilateral functional free fibular microvascular flaps containing reinnervated muscle. This created a well-vascularized body, ramus, and condyle bilaterally within an adequate soft-tissue envelope. Postoperatively, the overjet was reduced to 5 mm. The patient can now actively move his mandible. Airway diameter increased to 10 mm, and the patient is able to tolerate intermittent tracheostomy plugging. This innovative combination of techniques allows early intervention, limits graft resorption, and improves airway control.

A comparison of bupropion hydrochloride with dexamphetamine and amitriptyline in healthy subjects

1 The effects of bupropion, a potential antidepressant drug, has been investigated in twelve healthy subjects, (six men and six women) in a double-blind controlled, balanced study, and compared with dexamphetamine and amitriptyline. Analysis of variance was used to assess significance of differences with P < 0.05 taken as significant.

2 Bupropion 50 and 100 mg (HCl) failed to differ from lactose on any of the measures of performance tested. By contrast amitriptyline 25 mg (base) impaired auditory vigilance, tapping rate, and short term memory and prolonged auditory reaction time. Dexamphetamine 10 mg improved auditory vigilance and tapping rates and dexamphetamine 5 mg produced similar trends.

3 Bupropion did not differ from lactose on heart rate, pupil size and salivary secretion. Amitriptyline produced miosis and dexamphetamine 10 mg mydriasis and increased heart rate. Dexamphetamine 10 mg increased systolic blood pressure (BP) when taken erect and supine. Supine systolic BP was increased, compared with lactose, after all treatments except bupropion 50 mg, possibly due to a spuriously low mean after lactose. These changes were not seen when standing and no changes ascribable to treatments were recorded in diastolic BP.

4 No changes in the electroencephalogram (EEG) occurred after bupropion or dexamphetamine. Amitriptyline increased activity in the delta band (2.3-4 Hz) and decreased in the alpha band (7.5-13.5 Hz).

5 Bupropion produced no changes in subjective ratings measured with visual analogue scales. Amitriptyline produced drowsiness, sedation and physical impairment, whereas dexamphetamine increased alertness and produced elation and increased sociability. No side effects could be ascribed to bupropion with any certainty.

6 It was concluded that bupropion differs in its pharmacodynamic properties from both dexamphetamine and amitriptyline. At the doses examined the drug is devoid of stimulant and sedative properties. In addition, no cardiovascular or anticholinergic effects occurred and in view of these potential advantages over available antidepressant drugs, further clinical studies are in progress.

Changes in the human light reflex as a measure of the anticholinergic effects of drugs. A comparison with other measures

Single oral doses of atropine, nortriptyline, procyclidine and lactose dummy were administered double-blind to eight healthy young subjects in a balanced, crossover study. Television pupillometry was used to measure the anticholinergic effects of these drugs on the pupil diameter in darkness and the reflex response to light flashes. The sensitivity of this method was compared with conventional autonomic function tests, viz. salivary secretion, radial pulse, forearm sweat gland activity and distance to visual near point. Visual analogue scales were used to obtain subjective measures of sedative drug effects. The expected inhibition of parasympathetic activity was found in most instances with two exceptions: firstly, that nortriptyline failed to affect the pupil despite causing a tachycardia and secondly, that procyclidine gave a bradycardia. The results are discussed with reference to the possible advantages of television pupillometry over conventional pupil measurement in the detection of anticholinergic drug effects.